Averting disaster
Will the recently announced £3m for additional dental training places have the desired effect?
With a new year comes optimism. A fresh start for work, life and a hope that the weather improves. Unfortunately, I’m not feeling much optimism for our profession. I feel there is a real transition in the way our profession is portrayed in both our professional and the mass media.
I also feel that the way younger professionals work and their business models are changing. As an older professional, I am certainly resistant to change, however, I’m probably old enough that any major changes are unlikely to affect my working patterns. So, I am looking at these changes more as an interested observer than a participant.
I’ve written before about the various elements I’m about to describe, however, as time passes, I notice a range of changes coalescing into a more coherent pattern. A pattern which gives me some concern but should be causing a lot more interest at the highest levels. Our governments (Scottish and UK) repeatedly tell us they’re investing in NHS dentistry. Creating hundreds of thousands of new appointments. Having 95% of the population registered with a dentist. And yet, there are scores of patients searching for dentists to no avail.
Furthermore, the exodus to private care continues. Dental influencers tell us about the financial benefits of clear aligners and composite bonding and how these one-off treatments are the key to high margin, low turnover work. High-end treatments that provide professionals with fees we deserve while carrying out the kind of work we aspire to perform in clinics more akin to spas in five-star hotels than NHS surgeries in health centres. This is the way of the future… perhaps?
My fear for this type of dentistry is that it makes for a difficult future. I can’t say that it’s wrong for an individual to look at this type of care and not be wooed by the professional and fiscal rewards, the low throughput patient model and the potential for an amazing work-life balance. What concerns me is how that new model works.
A traditional high street dentist has many registered patients with the vast majority receiving little or no care other than checkup, routine radiographs and PMPR. There are certainly evidence-based question marks for the frequency and efficacy of this type of care. However, the benefit of a longitudinal relationship for the patient with a buildup of trust and knowledge flowing in both directions is that it leads to a well-cared for patient and a business with regular profits and a saleable asset to aid retirement planning. It also results in a large number of patients with good levels of oral health and access to pathways for the use of secondary care.
In a specialist-based model with a focus on one-off treatment, the ‘referrals’ tend to come from marketing through social media and patient self-referral. This requires a high number of leads to be generated with a likely low level of uptake. During these assessments, does the specialist advise the need for care they don’t provide and, more importantly refer this to someone else or simply leave it up to the patient to arrange this? If not looking after routine care, then this model doesn’t create a continued asset or patient base. The business itself relies almost entirely on the value of the practitioner and their skills. There is little or no intrinsic value to the business without the talented specialist.
This model doesn’t help the NHS to function. It doesn’t help dentistry to function. Because there will be fewer GDPs, less access to routine care and the pathways it creates and, regardless of whether it is NHS or private care, the population won’t be cared for. The more private the General Dental Service becomes, the worse this will be. The more skewed care will be to those with the funds to pay. NHS will be less and less available, driving health inequalities. Patients will receive less care.
The counter to this is that the drive to private dentistry may reduce the wealth of the profession. There is only so much gold in the pot for private care. If the number of dentists chasing that gold increases, then costs will fall as dentists cut costs to buy work. This will destabilise the economic balance of the profession. Perhaps this is what the governments are relying on? Do they believe that the direction of travel of the profession will move full circle to shift young professionals back into the health service? Ultimately, I believe they neither have the nouse for that nor the patience. Or that young professionals want to jump on the NHS hamster’s wheel.
The Scottish Government has announced £3 million for training. Is this a one-off? Is it for dentists, DCPs, technicians? Is it year-on-year funding to provide a concerted effort to improve the recruitment crisis we find ourselves in or a drop in the ocean that will do nothing to change our collective fate? Will the rest of the UK follow suit and realise the depths of the workforce planning hole we have found ourselves in.
I believe £3m a year to train more people in the existing pathways may be a start. If it’s to create different mechanisms of training, that simply isn’t enough. If you were trying to open or re-open another dental school, that won’t even get you through the planning stages. What I hope, is that this is the start of a serious drive to address the real problem facing our profession. It’s not contracts, throughput, business models or frequency of care. It’s a simple lack of staff or, more accurately, whole time equivalents. If that can be boosted, then we can avert the impending disaster.
Author
Arthur Dent is a practising NHS dentist in Scotland. Have a question for Arthur? Email arthurdent@sdmag.co.uk, leave comments below to further discuss this article.